Kirsty Duncan

[Child Development, December 4th, 2009]

Mr. Speaker, sadly, over a million children live in poverty in Canada.

Better Beginnings, Better Futures is one of the most ambitious research projects on the long-term impacts of early childhood development programming ever initiated in Canada.

Its purpose is to prevent young children in low-income, high-risk neighbourhoods from experiencing poor developmental outcomes which then require expensive education, health and social services. The Better Beginnings, Better Futures model has been implemented in several communities in Ontario since 1991.

This program has given beneficial effects to the children who have grown up with it, including a reduction of behavioural and emotional problems, and a promotion of positive development.

I would like to congratulate Highfield Junior School, its excellent teachers, caring parents, and community for terrific programs that will give our children important opportunities to enjoy a healthy and happy life.

[December 2nd, 2009]

Mr. Speaker, what contingency plans were put in place should there have been a delay in vaccine production, as is possible with 1950s egg-based technology? What newer production methods will the government explore going forward?

Canadians want a safe vaccine delivered quickly to as many arms as possible. Hospitals and health care workers want a reliable vaccine, namely, ordered doses delivered. Some have stated that they had done their job planning over the last few years and were ready to respond. Some also stated that they felt let down by the federal government which did not deliver a steady supply of vaccine.

These are important questions that require answers. This is not about politics, but rather, about putting the health of Canadians first. A post-pandemic audit would allow the government to learn what went right and what went wrong so that we will all be better prepared next time.

[December 2nd, 2009]

Mr. Speaker, in preparing, responding to and recovering from the H1N1 pandemic, Parliament's focus must be the health and welfare of Canadians. Specifically, our goals must be to reduce the rate of hospitalizations, illness and death, as well as to reduce economic and social impacts. Therefore, our discussions must remain on the winding down of the second wave, as well as preparing for a possible third wave.

Having said this, we are here to address a question regarding the timing and roll-out of the vaccine, which will be, by nature, a postmortem analysis.

The government had two major roles in responding to the pandemic: the distribution of the vaccine to the provinces and territories; and a comprehensive communications plan.

My focus here is the vaccine, its ordering, its production, the timing of its delivery and what delays in shipment meant to the front line workers for planning vaccine clinics and for worried Canadians, particularly pregnant moms, who wanted to know whether to wait for the unadjuvanted vaccine.

First, we must examine the contract with GSK. The first rule in pandemic planning is back-up, back-up, back-up. The fact that vaccine was later ordered from Australia suggests there was perhaps wiggle-room to negotiate with GSK and to ensure a second supplier should there be slowdowns.

Because WHO recommended finishing the seasonal vaccine prior to producing the H1N1 vaccine, production of the pandemic vaccine could not begin until the warehouse was cleared. The government could have made a full gesture and decided to follow the evidence and switch to the pandemic vaccine right away.

Second, we must examine the order date. We were told in committee the order date was August 6. The government's own answer to my written question on the order paper was actually August 19, or two weeks later.

Why were health committee members given incorrect information? Why did the government not order the British vaccine for those with serious egg allergies. Instead, those with mild allergy were told to have the vaccine with the allergists, who were not initially supplied with it. Those with severe allergy were told not to take it. Where was the protection for those who suffered from the eight most common food allergies?

Third, why was unadjuvanted vaccine not ordered on the 19th? WHO recommended the unadjuvanted vaccine in July for pregnant women. Had the government forgot that pregnant women fared poorly during pandemics and needed protection? I do not think so, as I brought up this point at the very first meeting with the officials. I reminded the officials how pregnant women fared in 1918, 1957 and 1968. Why, then, did the government make pregnant women an afterthought and at last ordered vaccine in September?

Fourth, why did the government gamble on the date of the pandemic? Other countries predicted an earlier start date and began vaccinating in late September and early October, an important time of year, as children had returned to school where viruses spread easily. More important, scientists warned that the H1N1 hit young people the hardest for months, prior to the government's ordering of vaccine?

Why did the government wait to protect our most vulnerable, unlike the Americans, who began protecting their children three weeks earlier? What was the government's contingency plan to protect Canadians during the possible time period with no vaccine? More important, how many Canadians were not only vaccinated, but actually protected before the second wave peaked, meaning 10 to 14 days had elapsed post-vaccine?

[World Autism Awareness Day Act, November 23rd, 2009]

Mr. Speaker, my adopted kids were born healthy, but early in their lives their families noticed that their personalities were different from those of other babies of the same age. They hit milestones later and they increasingly showed little awareness of the outside world. Their words became fewer and they banged or chewed their toys, rather than playing with them. Tantrums were common, and others were quick to judge them when, for example, the child flapped his or her arms or shoved a nearby adult who had ventured too near. Even birthday parties or grocery shopping could be distorted by outbursts of anger and frustration.

Eventually the parents received the diagnosis of autism spectrum disorder, which is often made harder by a lack of understanding of those around them.

Most parents are concerned with whether their children will be engineers, lawyers or teachers, and whether their children will find happiness and marry. My adopted kids' parents faced the very real questions of whether their children would lead independent lives or not, and who would look after them when they, the parents, were no longer around.

Autism spectrum disorder, or ASD, is a neurological condition that causes a range of developmental disabilities. Some people can function well, while others are locked in a world of their own.

Today ASD occurs in 1 in 165 children, representing an increase of 150% in the last six years, and there is no explanation for the dramatic increase. Worldwide more children are affected by autism than AIDS, diabetes and pediatric cancer. In Canada a total of 48,000 children and 144,000 adults have some form of ASD.

A child who shows a number of the following characteristics and behaviours would likely be diagnosed with autism: if he or she shows no interest in other people; does not know how to play with or talk to people; develops language and speech skills slowly, or not at all; can only initiate and maintain conversations with difficulty; and repeats ritualistic actions, such as rocking, spinning or staring.

A person with a mild case could go for years and may only be detected when he or she goes through a crisis that brings them into contact with professionals who are able to recognize the disorder.

There is no known cause, but research is focused on differences in brain function, environmental factors, genetics, immune responses and viral infections.

No single test will confirm that someone has ASD. Some people with mild forms of autism may never need treatment, as they may function well and even excel. However, those with severe forms of the disorder cannot function and may benefit from active therapy.

There are several ways that people with autism are treated. Applied behavioural analysis and intensive behavioural intervention are designed to actively engage the children with behavioural, communication, learning and socialization problems. Therapy can be extremely expensive, as it may involve one-on-one teaching for up to 40 hours per week, with costs ranging from $30,000 to $80,000 a year. Other therapy may include counselling, development of motor and language skills, diet and medication and physiotherapy.

It takes hard work, patience and sheer determination to help navigate the system and allow a child to emerge from the bonds of autism. The physical and psychological strain on a family can be overwhelming, and the isolation profound. I am therefore honoured to rise in the House to speak in support of Bill S-210, An Act respecting World Autism Awareness Day.

I would first like to thank the sponsor of the bill, Senator Munson, as well as my many colleagues in the House who have been supporting and advancing this cause. I also thank Senator Eggleton, who was the chair of the standing Senate committee that provided an extensive report on funding for autism, entitled “Pay now or Pay Later”.

Bill S-210 calls for Canada to join with member states of the United Nations to focus the world's attention on autism each April 2.

World Autism Awareness Day shines a bright light on autism as a growing global health crisis, and it is one of only three disease-specific United Nations days. It reflects the UN's deep concern about the prevalence and high rate of autism in children in all regions of the world, and the consequent development challenges for long-term health care, education, training and intervention programs, as well as its tremendous impact on children, their families, communities and societies.

This day also acknowledges the extraordinary talents of people living with autism, as well as their ongoing struggles and those of their caregivers, families and friends.

This bill will not change the reality of families affected by autism, people such as Jacob, Dee and Mary in my community. Jacob is a beautiful little boy with long eyelashes, who loves technology and is an accomplished photographer. His prizewinning picture of owls is front and centre on my desk at work. His mother, Dee, left her job to focus full-time on Jacob. She and Aunt Mary, an 82-year-old who is currently recovering from heart surgery, are his greatest advocates, but they still have to fight every day to get treatments and to make the sacrifices necessary to pay for those treatments.

This bill will increase Canadians' opportunities to learn about autism and to recognize that in their communities there are families living with ASD, people like our Jacob, who is a superstar.

Last year the United Nations hosted a rock concert by Rudely Interrupted, whose members have various disabilities, including ASD. The words of lead singer Rory Burnside were especially inspiring:

My advice to kids who have some form of disability is: don’t let it stop you. Use it as your strength; don’t use it as your weakness. One red light can lead to a whole bunch of green lights, with a few orange lights thrown in. And the red lights are just a bit of a test.

I have seen first-hand what caring people who work tirelessly can achieve. We must change the future for all those who struggle with ASD. That means each of us must fight hard for every Jacob in our community, and when roadblocks are put in front of families, we must work all the harder. We must fund research into the causes, prevention, treatment and cure for autism and raise public awareness about autism and its effects on individuals, families and societies.

In 2006, the United States' Combating Autism Act authorized nearly $1 billion in expenditures over five years to help families with autism. We must bring hope to all of those who deal with the hardships of this disorder and we must develop a national strategy on autism.

I am proud to share with you that we have formed an all-party subcommittee to address neurological disease and to bring researchers, stakeholders and decision-makers together on ASD, MS, ALS, Alzheimer's disease and Parkinson's disease, all of which are major neurological diseases that cross all ages.

One in three, or 10 million, Canadians will be affected by a neurological or psychiatric disease, disorder or injury at some point in their lives. NeuroScience Canada estimates that about $100 million at most is invested in operating costs for neuroscience research in Canada annually. This compares with a burden of disease in the order of $20 billion to $30 billion, a ratio of 200 to 1.

This past April, Yoko Ono unveiled Promise, a mural created especially for World Autism Awareness Day. It consisted of 67 pieces, representing the 67 million autism sufferers around the world. The pieces were to be broken apart and auctioned off individually. With each winning bid came the promise that when the cure for autism is finally found, all the pieces will be reassembled for a day. Promise, just like World Autism Awareness Day, symbolizes the coming together of society around people with autism and the unfinished work of the world in finding the causes and cure for the disorder.

Let us keep the promise. Autism speaks: it is time to listen.

[Questions Passed as Orders for Returns, November 20th, 2009]

With respect to the current pandemic of new influenza A (H1N1): (a) what specific healthcare professional stakeholder groups have been consulted since the beginning of the H1N1 pandemic, what was the consultation process, and what concerns were raised; (b) what concerns from the consultation process have been addressed, what concerns are remaining, and by what date will they be addressed; (c) what, if any, additional funding was requested to address identified challenges; (d) do identified stakeholder groups report there are sufficient human resources and supplies to meet the need during a second wave of H1N1 and, if not, what are the identified gaps; (e) what, if any, additional education and training was requested by stakeholder groups; (f) what procedures are in place to ensure applicability, consistency and clarity of protocols to healthcare professional organizations, and do stakeholders report that they are receiving clear, concise, timely messaging; (g) what, if any, differences exist in how healthcare professionals will be protected among provinces and territories; (h) what specific agreements have been made in respect to assuring sufficient human resources during a second wave; (i) what, if any, differences exist between the national guidelines and those of the provinces and territories, with respect to antivirals, N-95 masks, vaccines, and other personal protective measures, and how should healthcare professionals address any discrepancies; (j) what are the known and suspected benefits and risks of the H1N1 vaccine; (k) what non-clinical and clinical trials have been or are being undertaken regarding the H1N1 vaccine, on what dates were they completed, and what are the outcomes of these trials; (l) what possible side effects, including rare events, might be expected with the H1N1 vaccine; (m) what are the possible legal risks associated with an H1N1 vaccination programme, and what efforts have been taken to reduce these risks; (n) what, if any, plans exist for rapid distribution and administration of vaccines for the first mass vaccination effort; (o) what special efforts are being made to reach out to young adults, minorities, and other at-risk groups to get vaccinated, and what languages and media outlets are being used; (p) for how long will vaccination campaigns continue past the fall in case of a possible third wave; (q) how do hospitals across the nation vary in their ability to bear the burden of H1N1 cases; (r) what percentage of hospitals are operating at their limit today; (s) what percentage of hospitals will be able to accommodate the predicted surge capacity if 15%, 35% and 50% of the population is impacted by H1N1; (t) what percentage of hospitals will be expected to meet intensive care unit (ICU) and ventilator surge capacity if the above percentages of people are affected; (u) do any hospitals or provinces and territories had difficulty meeting surge capacity in the spring and summer; (v) what, if any, surge capacity challenges existed in the spring and summer in terms of hospitalizations, ICU stays, and ventilator use, and what measures have since been taken to address these challenges; (w) what, if any, funding has been given to address surge capacity challenges; (x) what specific efforts are being taken to help reduce the burden on hospitals by distributing high profile messages about when to seek medical care for pandemic H1N1 infections; and (y) what is being undertaken to reduce the risk of resistance (i) in patients with severely compromised or suppressed immune systems who have prolonged illness, have received oseltamivir treatment, but still have evidence of persistent viral replication, (ii) in people who receive oseltamivir for post-exposure prophylaxis, and who then develop illness despite taking oseltamivir?

[Health, November 18th, 2009]

Mr. Speaker, headlines across the country are clear, “Not enough vaccine for all until Christmas”. According to Dr. Butler-Jones, there will not be enough vaccines for all Canadians by the end of 2009. The government broke its promise. Our front line medical workers need more help from the government if they are going to vaccinate as many Canadians as possible.

Will the minister now commit the additional resources to get this done?

[Health, November 18th, 2009]

Mr. Speaker, for weeks the Minister of Health incorrectly told Canadians that they could all be vaccinated by Christmas. Now the minister has to admit, and Dr. Butler-Jones has confirmed, that at least seven million Canadians will be left behind until well into next year.

Why did the minister mislead the House? More seriously, why did she fail to tell Canadians the truth?

[Questions Passed as Orders for Returns, November 17th, 2009]

With respect to the current pandemic of new influenza A (H1N1): (a) what is the key leadership shown by the organizational reporting chart, from the two lead ministries, the Public Health Agency of Canada and Public Safety Canada, through to the deputy ministers; (b) what is the decision-making process to determine which of the two ministries leads on issues; (c) what, if any, funding requests have been made by government departments for pandemic planning since the beginning of the pandemic in Canada; (d) what, if any, additional funding is required to ensure all government departments have tested their H1N1 plans and rolled them out to their employees; (e) what, if any, specific agreements have been signed with the provinces and territories, and which, if any, agreements still need to be signed; (f) what are the government’s identified critical services, what is the decision-making process to reduce services if required, and who has responsibility for these decisions; (g) how will the government acquire and distribute medical countermeasures if required; (h) what guidance is being provided to foreign missions, including consulates, embassies, high commissions and trade offices, and what is the decision-making process to reduce services, or repatriate staff; (i) what guidance is being provided to the Canadian Forces, including the army, the air force and the navy, and what recommendations are being made for military personnel; (j) with regard to recommendations being made to the Canadian Forces and military personnel concerning vaccinations, what processes are in place to (i) re-evaluate policies as required, (ii) ensure legal compliance and respect ethical considerations, (iii) ensure protection of our troops in Afghanistan; (k) on what date was the pandemic vaccine ordered, and what, if any, effect did having only one supplier, or the decision to use adjuvant, had on the delivery date for the H1N1 vaccine; (l) what, if any, actions is the government taking to investigate claims of unpublished Canadian data regarding vaccination, and what updates are available in Canada and internationally; (m) what, if any, recommendations will the government make in terms of timing of seasonal and H1N1 vaccines, why was priority setting or sequencing different from that of the World Health Organization, and what considerations have been given to possible impacts of varying provincial and territorial vaccination plans on short-term and long-term trust in public health officials and vaccination rates; (n) what, if any, oversight exists to ensure Canadian communities have H1N1 pandemic plans in place, and what specific recommendations are being made for those who live in poverty or in crowded housing conditions, including prisons and shelters; (o) what, if any, gaps exist in medical surge capacity; (p) what, if any, monitoring is being undertaken for influenza-like illness in daycares, schools, colleges, and universities, and, if so, what patterns are occurring; (q) what percentage of people who died of H1N1 during the last four months had secondary bacterial infection, and what, if any, underlying health conditions did they have, and how might possible secondary bacterial infections be reduced in at-risk populations; (r) what, if any, ethical guidelines are in place to allow for consistent decision-making regarding ventilators; (s) what research, if any, has been undertaken to determine what percentage of healthcare workers might be concerned to work during a possible second wave, and what mitigating efforts have been taken to address this possible challenge; (t) what, if any, recommendations exist regarding “duty to care” and institutional supports to healthcare workers during a pandemic; (u) what efforts are being taken to boost vaccination rates among pregnant women, and how is this information being conveyed to medical practitioners and expectant mothers; (v) what, if any, consideration has been given to the construction of field hospitals in remote and isolated areas; (w) with historical hindsight, and knowledge of increased vulnerability to H1N1 of Aboriginal communities due to underlying health conditions and socio-economic problems, what, if any, containment measures were taken to slow the spread of the H1N1 virus in the spring; (x) what preventive and treatment measures are being implemented to reduce the percentage of Aboriginal people who will be hospitalized, who will stay in intensive care units, and who will die, compared to the whole of the Canadian population; and (y) what, if any, consideration has been given to share a portion of Canada’s antiviral medication, vaccine allotments, and flu management kits with developing countries?

[Questions Passed as Orders for Returns, November 16th, 2009]

With respect to the current pandemic of new influenza A (H1N1): (a) who is at the top of the pandemic organizational chart for the country; (b) what gaps still exist in the government’s overarching plan, recognizing that it is an ever-evolving plan, and by what date will identified gaps be addressed; (c) what money remains from the $400 million contained in the budget of 2006 as ‘to be set aside as a contingency to be accessed on an as-needed basis’; (d) what funds have been spent since the start of the pandemic in Canada to address response, specifically, (i) what government departments have tested their pandemic plan, (ii) what departments operationalized their plans or part of their plans in the spring, and updated their plans since the lessons learned from the spring; (e) should there be an election, what is the pandemic preparedness plan for Elections Canada, both to protect the health and well-being of its employees and Canadians; (f) what are the outstanding issues among medical personnel in terms of preparedness, and how are these issues being addressed; (g) what was the process for monitoring swine herds prior to April 24, 2009, and how has it increased since that date; (h) what is the purpose behind the absence of a Canadian notifiable swine influenza surveillance system; (i) what is known of the clinical spectrum of the disease at this time, and what are the possible long-term impacts on lungs, and other organs, and potential long-term costs to the healthcare system; (j) by what date are provincial and territorial vaccine distribution plans to be in place, what oversight exists to ensure they are in place, and will they be made public; (k) what contingency plans are being put in place should Canadian distributors run out of stock of N95 masks; (l) will there be a compensation package should there be challenges with the vaccine; (m) what recommendations are being made to those with chronic conditions, such as cardiovascular disease, diabetes, and immunocompromised patients, and how is this information being relayed to these groups to see their doctor now; (n) what are the details of the “alternative strategies” being developed by provinces and territories; (o) what are the details of adding a “small amount of amantadine” to the National Emergency Stockpile System, and is its use in combination thought to be effective when the virus is resistant to amantadines; (p) are there any other alternative therapies being explored to address antiviral resistance and, if so, what funds are being allocated to the effort; (q) will 500 ventilators meet the potential intensive care unit (ICU) burden considering Canada’s ICU cases were around 20% of its hospitalized, compared to 15% in

[Questions Passed as Orders for Returns, November 16th, 2009]

With regard to the current pandemic of new influenza A (H1N1) virus in Aboriginal (First Nations, Inuit, Metis) communities in Canada: (a) what were the containment measures taken to slow the spread of the virus within households, between households, and among communities; (b) what were the control measures taken in more remote areas to flatten the epidemiological peak; (c) what was the average length of time from symptoms to treatment for those Aboriginal peoples who required a stay in intensive care unit (ICU); (d) what percentage of hospitalizations, ICU cases, and deaths were among Aboriginal peoples, and how do these compare with the Canadian population at large; (e) what was the average length of time on a ventilator and the mean length of stay in an ICU for Aboriginal peoples; (f) what specific measures are being planned to reduce the time to treatment, hospitalizations, ICU, and deaths; (g) when will the results of the preliminary investigation in First Nations communities be available, specifically, (i) how many Aboriginal communities in Canada have a revised H1N1 pandemic influenza plan, (ii) how many have tested their plan, (iii) how many have necessary supplies in place; (h) what specific actions have been undertaken to address the fact that only two of 30 communities in northern Manitoba had a pandemic plan, and none had been tested; (i) where did the Minister of Health obtain the 90 percent figure she used in her August 28 response letter to Drs Bennett and Duncan; (j) what funding have Aboriginal communities requested, and what additional funds have been made available to Aboriginal communities for pandemic planning and response in 2009; (k) is there any encouragement to identify vulnerable people, such as pregnant women and those with underlying medical conditions, to take additional precautions, specifically, (i) how many communities lack necessary clean water for infection control measures, (ii) what funding and progress has been made to address this situation; (l) what measures are being put into place to decrease transmission in households where there is overcrowding; (m) are all Aboriginal people on the priority list for vaccine, or just communities in remote and isolated settings; (n) are anti-virals pre-positioned in all Aboriginal communities, should they be required urgently, and are there provisions for communities without registered nurses; and (o) what measures exist to ensure that remote and isolated communities will have the necessary human resources to ensure appropriate and timely treatment, particularly in communities where weather may impact help?